Chemo Experts, the easiest way to learn about cancer treatment
Find a Treatment:
Cancer Types
or
Treatments
listen

Tap along the timeline to move to different parts of the audio file.

Treatment Name: DA-EPOCH-R (Etoposide + Prednisone + Vincristine + Cyclophos­phamide + Doxorubicin + Rituximab)

DA-EPOCH-R (Etoposide + Prednisone + Vincristine + Cyclophos­phamide + Doxorubicin + Rituximab) is a Chemotherapy Regimen for Lymphoma, B-cell

DA - Dose Adjusted
E - Etoposide
P - Prednisone
O - Oncovin (vincristine)
C - Cyclophosphamide
H - Hydroxydaunorubicin (doxorubicin)
R - Rituximab

How does DA-EPOCH-R work?
Each of the medications in Dose-Adjusted EPOCH-R (DA-EPOCH-R) are designed to kill cancerous blood cells known as B-lymphocytes.

Goals of therapy:
DA-EPOCH-R is given to shrink tumors and reduce symptoms. It is commonly given with the goal of cure.

listen

Tap along the timeline to move to different parts of the audio file.

Schedule

  • Prednisone is a tablet taken by mouth TWICE daily on Days 1, 2, 3, 4, 5
  • Rituximab is an intravenous (I.V.) infusion on Day 1 (time of infusion varies)
  • Doxorubicin is an I.V. infusion given over 24 hours on Days 1, 2, 3, 4
  • Etoposide is an I.V. infusion given over 24 hours on Days 1, 2, 3, 4
  • Vincristine is an I.V. infusion given over 24 hours on Days 1, 2, 3, 4
  • Cyclophosphamide is an I.V. infusion given over two hours on Day 5
  • On Day 6, filgrastim (Neupogen®) is started subcutaneously once daily and continued every day until the white blood cell count returns to normal. Alternatively, some Doctors prefer to give one dose of pegfilgrastim (Neulasta®) after each cycle of dose-adjusted EPOCH-R

Patients then have labs drawn twice weekly until the white blood cell count has recovered.

Typically, etoposide, doxorubicin, and vincristine are mixed together in one intravenous infusion bag and each bag is infused over 24 hours on Days 1, 2, 3, and 4 of each cycle (96 hours total). Often, patients spend upwards of 8 hours at the infusion center for Day 1 of Cycle 1; then as short as 3 hours for Day 1 of subsequent cycles. When patients come back on day 5, they may spend upwards of 2 hours at the infusion center getting the continuous infusion of chemotherapy disconnected, and to receive cyclophosphamide.

This regimen is referred to as "Dose-adjusted" EPOCH because the doses of doxorubicin, etoposide, and cyclophosphamide may be increased, decreased, or remain the same with each new cycle. This is done to ensure that the chemotherapy doses are as aggressive as possible to treat the cancer, without causing too many side effects.

Click below for dosing with each dose level
Level -2 (minus 2)
Level -1 (minus 1)
Level 1
Level 2
Level 3
Level 4
Level 5
Level 6

DA-EPOCH-R may be given entirely in the hospital during a 5- or 6-day stay or as an outpatient (at clinic or at home). For example, DA-EPOCH-R may be started in the clinic on Day 1, continued at home through Day 4, with the patient returning to the clinic on Day 5. Outpatient DA-EPOCH-R may require a clinic visit on Day 1 and 5, but Days 2, 3, and 4 can be administered at home using a small, portable infusion pump.

DA-EPOCH-R is typically repeated every 21 - 28 days. This is known as one Cycle. Each cycle may be repeated up to 8 times, depending upon the stage of the disease. Duration of therapy may last up to 8 months, depending upon response, tolerability, and number of cycles prescribed.

Additional medicines that may be prescribed:
1. Bactrim® (Sulfamethoxazole/Trimethoprim) to prevent Pneumocystis Pneumonia
2. Omeprazole (Prilosec®) to prevent stomach ulcers from prednisone
3. Docusate/Senna (Senna-S®) to prevent constipation from vincristine

listen

Tap along the timeline to move to different parts of the audio file.

Side Effects

In a multi-drug regimen, each medication has unique side effects. When these medicines are given together, drug-related side effects reported in clinical studies give the best estimate of what to expect. In clinical studies, the most commonly reported side effects with DA-EPOCH-R are shown here. Side effects sometimes have percentage ranges [example: 36 – 46% get infections] because they differed between in clinical studies:

  • Anemia [low red blood cells] (84%)
  • Increased bleeding risk [low platelets] (71%)
  • Neutropenic fever [infection due to low white blood cells] (36 - 46%)
  • Infusion reactions (28%)
  • Fatigue (16%)
  • Mouth sores (11%)
  • Bleeding (4%)
  • Damage to nerves that control muscles and movement (14%)
  • Damage to nerves that control sensory and touch (10%)
  • Neurological side effects (2.5%)

Side effect videos Side Effect Videos
Fatigue Fatigue Nausea and VomitingNausea and VomitingConstipationConstipationHair LossHair LossBleedingBleedingPainPainAnemiaAnemiaNeutropenic FeverNeutropenic FeverDiarrheaDiarrhea

listen

Tap along the timeline to move to different parts of the audio file.

Monitoring

How often monitoring needed?
Labs (blood tests) may be checked before treatment and twice weekly throughout treatment to determine the dosing level listed in the Schedule section above. Pre-treatment labs often include: Hepatitis B screening, Human Immunodeficiency Virus (HIV) screening, Complete Blood Count (CBC), Comprehensive Metabolic Panel (CMP), uric acid, lactate dehydrogenase (LDH), plus any others your doctor may order.

How often is imaging needed?
Imaging may be checked before treatment and then periodically during treatment to assess how the chemotherapy is working. Imaging may include: x-rays, computerized tomography (CT) scans, or positron emission tomography (PET) scans.

How might blood test results/imaging affect treatment?
Depending upon the results, your doctor may advise to continue chemotherapy as planned, or delay or switch therapy.

listen

Tap along the timeline to move to different parts of the audio file.

ChemoExperts Tips

  • Remember to take Prednisone TWICE daily on Days 1, 2, 3, 4, 5. If possible, try to take the morning dose with breakfast and the afternoon dose with dinner (not bedtime) as prednisone taken late at night can cause difficulty with sleeping
  • Premedications such as diphenhydramine (Benadryl®), acetaminophen (Tylenol®), and hydrocortisone (Solu-Cortef®) may be given before rituximab to help avoid infusion related reactions. The first dose of hydrocortisone on Day 1 may substituted for prednisone since prednisone is already part of the chemo treatment
  • The first dose of rituximab is often the hardest. It may lead to fever, shaking, and chills even if medications are given beforehand to help prevent these side effects. Side effects generally go away when the rituximab is stopped. It may be restarted at a slower rate. Most patients are able to receive the entire dose, although it may take longer. In most cases, after the first dose, rituximab can be given over 90 minutes
  • Allopurinol may be prescribed for the first cycle of chemotherapy to help prevent tumor lysis syndrome
  • Typically, filgrastim (Neupogen®) or pegfilgrastim (Neulasta®) is given after chemotherapy to stimulate production of white blood cells and avoid periods of neutropenia
  • A pharmacist should ALWAYS review your medication list to ensure that drug interactions are prevented or managed appropriately
  • Clinical trials may exist for B-cell lymphoma. Ask your doctor if any studies are currently enrolling in your area. If not, go to clinicaltrials.gov to search for other centers offering study medications

Patient Assistance & Co-payment Coverage

Patients under the age of 65 years, or those with private insurance plans:
If you have insurance and are looking for patient assistance or copay assistance for DA-EPOCH-R (Etoposide + Prednisone + Vincristine + Cyclophos­phamide + Doxorubicin + Rituximab), we have provided links that may help.

Visit our Patient Assistance page and click the links to various patient assistance programs for help paying for DA-EPOCH-R (Etoposide + Prednisone + Vincristine + Cyclophos­phamide + Doxorubicin + Rituximab). Depending upon your income, they may be able to help cover the cost of:

  • Rituximab
  • Etoposide
  • Pred­nisone
  • Oncovin®
  • Cyclo­phospha­mide IV
  • Hydroxy­dauno­rubicin

For Branded medications (may be available for generic medications too), check with the manufacturer to determine if a co-pay card is offered and if it could reduce your monthly copay.

  • If you are uninsured, check with the manufacturer to determine if you are eligible to receive medication at no cost.

Medicare and Medicaid patients (Patients 65 years or older):
The clinic providing treatment will likely pre-authorize medications and immune therapies such as DA-EPOCH-R (Etoposide + Prednisone + Vincristine + Cyclophos­phamide + Doxorubicin + Rituximab) and are the best source to help you understand drug cost.

  • Ask to speak with a patient assistance technician or financial counselor at the clinic or hospital administering this therapy.

Emotional Wellness

What is Emotional Wellness?
Emotional wellness is having a positive outlook balanced with a realistic understanding of current life events. This requires both an awareness and acceptance of your emotions. It is with this knowledge that you can develop a plan to take the necessary actions to positively impact your life.

Emotional wellness uses an ongoing process to continually reflect on the stressors of life in a constructive manner to move forward and create happiness.

Because emotional wellness is deeply connected with physical, social, and spiritual wellness, pursuing it often becomes particularly difficult in times of major illness. Despite this difficulty, working toward emotional wellness has been connected to improved treatment outcomes and a higher likelihood of achieving goals of therapy.

Learn more about pursuing emotional wellness while receiving treatment with DA-EPOCH-R (Etoposide + Prednisone + Vincristine + Cyclophos­phamide + Doxorubicin + Rituximab)

Individual Drug Label Information

Rituximab (Rituxan®)

  • Rituximab is an intravenous infusion
  • Acetaminophen (Tylenol®) and antihistamines (e.g. diphenhydramine = Benadryl®) should be given prior to each dosePatients should be screened for hepatitis B as rituximab can cause a re-activation of this infection
  • May cause vaccines to work less well. It is advised that vaccines be given two to four weeks prior to rituximab if possible
General Rituximab (Rituxan) Side Effects
  • May cause an infusion reaction, which could include skin reaction, shaking, chills, fever, or shortness of breath. These reactions may be severe, but are very rarely life-threatening
  • Infusion reactions does not usually happen after the first dose, but are possible
  • May increase the risk of infection. Your doctor may prescribe antibiotics to prevent certain infections associated with rituximab use
  • Click on the rituximab (Rituxan) package insert below for reported side effects and potential drug Interactions
See DailyMed package insert.

Etoposide (VP-16)

  • Etoposide is an intravenous (I.V.) infusion that is typically given over 30-60 minutes or in some instances, as a continuous infusion
  • Etoposide interacts with grapefruit juice and can cause increased exposure to etoposide if taken together
  • Dosage adjustments may be required for decreased kidney or liver function
General Etoposide (VP-16) Side Effects
  • Often causes temporary hair loss, which is usually reversible after stopping etoposide therapy
  • Gastrointestinal side effects such as diarrhea, mouth sores, nausea and upset stomach can be common
  • Although rare, it has been linked to the development of acute leukemia (2-12%) and typically occurs 2-3 years after therapy
  • May cause low blood counts (white blood cells, red blood cells, and platelets)
  • Click on the etoposide (VP-16) package insert below for reported side effects and potential drug Interactions

Side Effect Videos
DiarrheaDiarrheaHair LossHair LossFatigue Fatigue BleedingBleedingAnemiaAnemiaNeutropenic FeverNeutropenic Fever

See DailyMed package insert.

Pred­nisone

  • Prednisone is an oral medication, usually supplied as a white tablet
  • Prednisone may increase the risk of infection. Depending upon how much prednisone is taken, antibiotics may be prescribed to help prevent infections during treatment with prednisone
  • Should be taken with food and with a large glass of water to avoid stomach irritation or ulcers
  • Should be taken before 6 P.M. when possible, to avoid trouble falling asleep
  • May decrease the response to vaccines; vaccines may need to be repeated at a later date to obtain maximal response
  • If taken daily for several days or weeks, the dose of prednisone may need to be gradually decreased to avoid withdrawal symptoms
  • If you miss a dose, take the next dose as soon as possible
  • Should be stored at room temperature
General Prednisone Side Effects
  • May cause high blood sugar, weight gain, irritability, high blood pressure, difficulty sleeping, stomach ulcers, bone loss, muscle weakness
  • Click on the Prednisone package insert below for reported side effects and potential drug Interactions
See DailyMed package insert.

Oncovin® (Vincristine)

  • Vincristine MUST only be given by intravenous infusion. May NOT be administered any other way
  • Dosage may be reduced in patients with poor liver function
  • May interact with certain antifungal medications
  • Vincristine will cause death if administered into spinal fluid
General Oncovin (Vincristine) Side Effects
  • Nerve pain in hands or feet may increase after each dose. It is usually reversible if treatment is stopped or dose is adjusted
  • Hair loss is NOT common if this is given by itself
  • May cause constipation; preventative medicines may help decrease or avoid constipation
  • Leakage into skin or surrounding muscle may cause severe irritation (extravasation)
  • Click on the Oncovin (vincristine) package insert below for reported side effects and potential drug Interactions

Side Effect Videos
ConstipationConstipationPainPain

See DailyMed package insert.

Cyclo­phospha­mide IV (Cytoxan®)

  • Cyclophosphamide is administered as an intravenous (I.V.) infusion
  • May decrease the ability to become pregnant. Fertility preservation is recommended in couples wishing to become pregnant.
  • A smaller dosage may be required for patients receiving hemodialysis
  • Has been linked to the development of other cancers in a small number of people
General Cyclophosphamide (Cytoxan) Side Effects
  • Low white blood cell count which can increase the risk of infection
  • Nausea or vomiting, which can be acute (first 24 hours) or delayed (Days 2 – 5)
  • Hair loss, which is usually reversible
  • Click on the cyclophosphamide (Cytoxan) package insert below for reported side effects and potential drug Interactions

Side Effect Videos
Nausea and VomitingNausea and VomitingHair LossHair LossNeutropenic FeverNeutropenic Fever

See DailyMed package insert.

Hydroxy­dauno­rubicin (Doxo­rubicin)

  • Hydroxydaunorubicin is administered as an intravenous infusion and is red in color
  • Can affect heart function. A heart study (echocardiogram) may be required before receiving the first dose
  • Dosage may be reduced in patients with poor liver function
  • Has been linked to the development of other cancers in a small number of people (1.5% chance at 10 years)
General Hydroxydaunorubicin (Doxorubicin) Side Effects
  • May cause nausea, vomiting, diarrhea, and mouth sores (stomatitis)
  • Leakage into skin or surrounding muscle may cause severe irritation (extravasation)
  • May temporarily turn urine orange
  • May cause hair loss, which is usually reversible
  • May increase the risk of infection due to decrease white blood cell count (neutropenia)
  • Click on the Hydroxydaunorubicin (Doxorubicin) package insert below for reported side effects and potential drug Interactions

Side Effect Videos
Nausea and VomitingNausea and VomitingDiarrheaDiarrheaHair LossHair LossFatigue Fatigue PainPainNeutropenic FeverNeutropenic Fever

See DailyMed package insert.

Share this page:

References

1. Dunleavy K, Pittaluga S, Maeda LS, et al. Dose-adjusted EPOCH-rituximab therapy in primary mediastinal B-cell lymphoma. N Engl J Med. 2013;368:1408:1416.

2. Wilson W, Jung S, Porcu P, et al. A Cancer and Leukemia Group B multi-center study of DA-EPOCH-rituximab in untreated diffuse large B-cell lymphoma with analysis of outcome by molecular subtype. Haematologica 2012; 97(5):758-765.

3. Wilson WH, Dunleavy K, Pittaluga S, et al. Phase II Study of Dose-Adjusted EPOCH and Rituximab in Untreated Diffuse Large B-Cell Lymphoma With Analysis of Germinal Center and Post-Germinal Center Biomarkers. J Clin Oncol 2008;26:2717-2724.

4. Jermann M, Jost LM, Taverna C, et al. Rituximab-EPOCH, and effective salvage therapy for relapsed, refractory or transformed B-cell lymphomas: results of a phase II study. Annals of Oncology 2004;15:511-516.

Created: August 24, 2015 Updated: August 13, 2018

What is Lymphoma, B-cell?

B-cell Lymphoma is a disease of the white blood cells known as B-lymphocytes which are normally found in lymph nodes, blood, and throughout the body. There are many different types of lymphoma, most of which are rare. Known causes of lymphoma may include immunosuppressive medications, infections such as HIV, while some causes are still unknown. The stage of lymphoma can vary at diagnosis and throughout treatment. The effectiveness of the treatment may depend upon the sub-type of lymphoma and stage at diagnosis.

NOTE: Treatment Options listed below are not all-inclusive. Other treatments may be available. ChemoExperts provides drug information and does not recommend any one treatment over another. Only your Doctor can choose which therapy is appropriate for you.

What is Tumor Lysis Syndrome?

Tumor lysis syndrome occurs when many cancer cells die quickly and release their contents into the bloodstream. Many times the body has the ability to flush these substances out through the kidneys or metabolize them via the liver. However, sometimes the body needs medicines to help eliminate these substances and to prevent organ damage.

Clinical Studies

If you are interested in reading the clinical trials results, please click on references below:

1. Dunleavy K, Pittaluga S, Maeda LS, et al. Dose-adjusted EPOCH-rituximab therapy in primary mediastinal B-cell lymphoma. N Engl J Med. 2013;368:1408:1416.

2. Wilson W, Jung S, Porcu P, et al. A Cancer and Leukemia Group B multi-center study of DA-EPOCH-rituximab in untreated diffuse large B-cell lymphoma with analysis of outcome by molecular subtype. Haematologica 2012; 97(5):758-765.

3. Wilson WH, Dunleavy K, Pittaluga S, et al. Phase II Study of Dose-Adjusted EPOCH and Rituximab in Untreated Diffuse Large B-Cell Lymphoma With Analysis of Germinal Center and Post-Germinal Center Biomarkers. J Clin Oncol 2008;26:2717-2724.

4. Jermann M, Jost LM, Taverna C, et al. Rituximab-EPOCH, and effective salvage therapy for relapsed, refractory or transformed B-cell lymphomas: results of a phase II study. Annals of Oncology 2004;15:511-516.

Dose Level -2 (minus 2)

  • Rituximab 375 mg/m2 I.V. infusion on Day 1 only
  • Prednisone 60 mg/m2/twice daily (total daily dose = 120 mg/m2) on Days 1,2,3,4,5
  • Doxorubicin 10 mg/m2/day, Etoposide 50 mg/m2/day (each mixed with vincristine) I.V. on Days 1,2,3,4
  • Vincristine 0.4 mg/m2 I.V. infusion over 24 hours on Days 1,2,3,4
  • Cyclophosphamide 480 mg/m2 I.V. infusion on Day 5 only

Dose Level -1 (minus one)

  • Rituximab 375 mg/m2 I.V. infusion on Day 1 only
  • Prednisone 60 mg/m2/twice daily (total daily dose = 120 mg/m2) on Days 1,2,3,4,5
  • Doxorubicin 10 mg/m2/day, Etoposide 50 mg/m2/day (each mixed with vincristine) I.V. on Days 1,2,3,4
  • Vincristine 0.4 mg/m2 I.V. infusion over 24 hours on Days 1,2,3,4
  • Cyclophosphamide 600 mg/m2 I.V. on Day 5 only

Dose Level 1

  • Rituximab 375 mg/m2 I.V. infusion on Day 1 only
  • Prednisone 60 mg/m2/twice daily (total daily dose = 120 mg/m2) on Days 1,2,3,4,5
  • Doxorubicin 10 mg/m2/day, Etoposide 50 mg/m2/day (each mixed with vincristine) I.V. on Days 1,2,3,4
  • Vincristine 0.4 mg/m2 I.V. infusion over 24 hours on Days 1,2,3,4
  • Cyclophosphamide 750 mg/m2 I.V. on Day 5 only

Dose Level 2

  • Rituximab 375 mg/m2 I.V. infusion on Day 1 only
  • Prednisone 60 mg/m2/twice daily (total daily dose = 120 mg/m2) on Days 1,2,3,4,5
  • Doxorubicin 12 mg/m2/day, Etoposide 60 mg/m2/day (each mixed with vincristine) I.V. on Days 1,2,3,4
  • Vincristine 0.4 mg/m2 I.V. infusion over 24 hours on Days 1,2,3,4
  • Cyclophosphamide 900 mg/m2 I.V. on Day 5 only

Dose Level 3

  • Rituximab 375 mg/m2 I.V. infusion on Day 1 only
  • Prednisone 60 mg/m2/twice daily (total daily dose = 120 mg/m2) on Days 1,2,3,4,5
  • Doxorubicin 14.4 mg/m2/day, Etoposide 72 mg/m2/day (each mixed with vincristine) I.V. on Days 1,2,3,4
  • Vincristine 0.4 mg/m2 I.V. infusion over 24 hours on Days 1,2,3,4
  • Cyclophosphamide 1080 mg/m2 I.V. on Day 5 only

Dose Level 4

  • Rituximab 375 mg/m2 I.V. infusion on Day 1 only
  • Prednisone 60 mg/m2/twice daily (total daily dose = 120 mg/m2) on Days 1,2,3,4,5
  • Doxorubicin 17.3 mg/m2/day, Etoposide 86.4 mg/m2/day (each mixed with vincristine) I.V. on Days 1,2,3,4
  • Vincristine 0.4 mg/m2 I.V. infusion over 24 hours on Days 1,2,3,4
  • Cyclophosphamide 1296 mg/m2 I.V. on Day 5 only

Dose Level 5

  • Rituximab 375 mg/m2 I.V. infusion on Day 1 only
  • Prednisone 60 mg/m2/twice daily (total daily dose = 120 mg/m2) on Days 1,2,3,4,5
  • Doxorubicin 20.7 mg/m2/day, Etoposide 103.7 mg/m2/day (each mixed with vincristine) I.V. on Days 1,2,3,4
  • Vincristine 0.4 mg/m2 I.V. infusion over 24 hours on Days 1,2,3,4
  • Cyclophosphamide 1555 mg/m2 I.V. on Day 5 only

Dose Level 6

  • Rituximab 375 mg/m2 I.V. infusion on Day 1 only
  • Prednisone 60 mg/m2/twice daily (total daily dose = 120 mg/m2) on Days 1,2,3,4,5
  • Doxorubicin 24.8 mg/m2/day, Etoposide 124.4 mg/m2/day (each mixed with vincristine) I.V. on Days 1,2,3,4
  • Vincristine 0.4 mg/m2 I.V. infusion over 24 hours on Days 1,2,3,4
  • Cyclophosphamide 1866 mg/m2 I.V. on Day 5 only

What is a CBC?

A Complete Blood Count (CBC) is a frequently ordered blood test that tells clinicians the status of your: 1) White blood cell count, 2) Hemoglobin, and 3) Platelet count at the time the test was taken.

Common uses:
1) White blood cell count (WBC): is used to determine infection risk, or response to chemotherapy. Certain chemotherapy agents may harm our good infection-fighting cells. Sometimes chemotherapy may need to be delayed to allow these cells to recover.

2) Hemoglobin: is used to determine if someone is anemic. Anytime the hemoglobin is below 12 g/dL, the person is said to be anemic. Red blood cell transfusions, and sometimes iron can be given to restore the hemoglobin level, but anemia treatment should always aim at treating the underlying cause or condition.

3) Platelet count: is used to determine if the risk of bleeding is increased or if a platelet transfusion is required to prevent bleeding. Certain medications that increase bleeding risk, such as: aspirin, certain chemotherapy agents, and blood thinners, may need to be stopped temporarily until the platelet count is within a safe range.

What is a CMP?

A Comprehensive Metabolic Panel (CMP) is a frequently ordered blood test that tells clinicians the status of your: 1) Electrolytes & Acid/Base status2) Kidney function, 3) Liver function, 4) Blood sugar, and 5) Calcium at the time the test was taken. It is commonly used to monitor liver and kidney function when beginning new medications such as chemotherapy. A total of 14 tests are run simultaneously and are shown below.

Electrolytes & Acid/Base status:
1) Sodium, 2) Potassium, 3) Carbon dioxide, 4) Chloride

Kidney Function:
5) BUN (blood urea nitrogen), 6) Serum creatinine (Scr)

Liver Function:
7) AST, 8) ALT, 9) Total bilirubin, 10) Alk Phos, 11) Albumin, 12) Total protein

Blood sugar:
13) Serum glucose

Calcium:
14) Serum calcium

What is neutropenia?

This occurs when there is an abnormally low amount of a certain type of white blood cells, called neutrophils, in the blood. These neutrophils help the body body fight infections caused by bacteria and viruses. Many chemotherapy drugs temporarily damage bone marrow where white blood cells are created, resulting in neutropenia. Please watch our video on neutropenia to learn more.

What does Cure mean?

The word “cure” means there are no cancer cells left in the body and cancer will never come back. Depending on the cancer type and stage, this may be the true goal of therapy. However, it is very difficult to prove all cancer cells are gone. Even though images, like X-rays and MRI’s, and blood tests may not show any signs of cancer, there can be a small amount of cancer cells still left in the body. Because of this, the word “remission” is used more often. This means there are no signs or symptoms of cancer. Patients in remission are followed closely for any signs of cancer returning. Sometimes, more chemotherapy may be given while in remission to prevent the cancer from coming back.

Doctors usually do not consider a patient “cured” until the chance of cancer returning is extremely low. If cancer does return, it usually happens within 5 years of having a remission. Because of this, doctors do not consider a patient cured unless the cancer has not come back within 5 years of remission. The five-year cutoff does not apply to all cancers.